Page 12 - Delaware Medical Journal - March/April 2019

Am I on the Spectrum?
A Case Report
Omar Shah, MD; Sahar Zaidi, MD; Erica Burgoon, PhD; Imran Trimzi, MD
Social (pragmatic) communication disorder (SCD) is a relatively new diagnosis in DSM-5. Major characteristics of SCD include difficulties with the following: understanding and following social rules of verbal and nonverbal communication, changing language according to the needs of the listener or situation, following rules for conversations and storytelling, and understanding what is not specifically and explicitly stated. Most of the individuals with autism spectrum disorder (ASD) have the above characteristics in common, but they are distinguished from SCD due to the presence of restricted, repetitive patterns of behavior, interests, or activities per DSM-5 and ICD-11 classification. A 10-year-old biracial male patient was admitted to a residential unit for increasingly unstable mood, self-injurious behavior, and making threats to harm his family. This case report illustrates challenges that clinicians may face in differentiating between ASD and SCD.
INTRODUCTION
Children develop communicative functions that enable them to
vocalize their intentions, express nonverbal communication, respond to communication from others, and interact and converse with others.
Development of communicative functions includes expressing a range of intentions such as greeting, giving information, and making requests. A child’s response to communication incorporates reacting to and understanding communication from others. Interaction of children includes
how they participate in conversation involving initiation, turn taking, and repair.
For normally developed children 7
years and beyond, more sophisticated functions of communication are developed: promising, hypothesizing, describing one’s feelings and emotions, describing others’ feelings and emotions, reasoning and evaluation, expressing abstract ideas and opinions, engaging
in arguments and debates, using hints and other indirect forms, expressing irony and sarcasm, and using complex and longer narratives. These children
understand the undertones of language, can judge utterances as appropriate for
a particular audience, can understand of social cues, e.g., being aware of politeness used in a conversation. These children can also interact and converse in a more sophisticated manner because they can use gestures, utterances,
and other nonverbal cues to explain
a narrative to others. They can repair broken conversations by starting off from where they left off or by explaining their point of view in a manner more easily understandable by their interlocutors. They can utilize abstract reasoning and
60
Del Med J | March/April 2019 | Vol. 91 | No. 2
Abstract